Spine Cancer and Spinal Cord Tumors: Causes and Treatment

Spinal tumors are abnormal growth (mass) of cells that develop in and along the spinal cord and spinal column. Spinal tumors can develop at different sites, which include:

• Bones of spinal vertebrae, including the bone marrow

• Cartilage and joints in the vertebrae

• Spinal discs present between the vertebrae

• Blood vessels in the spine

• Peripheral nerves

• Three layers of membranous casing of the spinal cord namely Dura mater, Pia mater, and Arachnoid mater

• Spinal cord

 These tumors can be benign (non-cancerous) or malignant (cancerous) and may vary in size. A cancerous tumor is characterized when the abnormal cells divide continuously and uncontrollably with the potential of spreading via the blood or lymphatic system. A small-sized tumor might not exhibit symptoms; however, if the tumor continues to grow, it can induce adverse health effects and cause damage to different tissues in the spinal column. Spinal tumors or growths can induce pain, neurological problems, and even paralysis. A spinal tumor can be life-threatening and may cause permanent disabilities. 

Types of spinal tumor –

In general, there are two types of spinal tumors classified based on their occurrence:

• Primary Tumors - Primary tumors generally originate in the spine by growing in the bones, discs, nerves, or other elements. They are rare and primarily non-cancerous.  

• Secondary Tumors – These are the most prevalent types of tumors that spread from another area of the body to the spine. Termed metastatic or secondary spinal tumor, nearly 90% of spinal tumors fall in this category.

Based on the location, spinal tumors can be categorized as:

• Intramedullary – Inside the spinal cord.

• Intradural-extramedullary - In the tissues (meninges) covering the spinal cord.

• Extradural - Between the meninges and bones of the spine.

• Vertebral tumors - In the bony vertebrae of the spine.

Causes –

The cause of a spinal tumor depends on its type: 

Primary spinal tumor - The cause of most primary spinal tumors is still unknown; however, scientists suspect that genetic defects or environmental factors like exposure to cancer-causing chemicals or substances can cause primary spine cancer.

Secondary spinal tumor - Metastases most commonly develop when cancer cells outbreaks from the primary tumor and enter the bloodstream. Lung, prostate, connective tissue, breast cancers, and lymphoma are the most common cancers that tend to spread to the spine.

However, in some case studies, spinal cord tumors were found to be linked to known inherited syndromes, such as neurofibromatosis-2 and von Hippel-Lindau disease.

Symptoms –

The symptoms of spinal tumors depend on the location, size, and type of the tumor. Back pain is the most common and primitive symptom of spinal tumors that worsens over time, even with treatment. Some spinal tumors cause no symptoms, while others trigger several symptomatic conditions, which include:

• Back pain, often radiating to other parts of your body and worsen at night.

• Pain at the site of the growth

• Feeling less sensitive to pain, heat, and cold

• Loss of bowel or bladder function

• Difficulty walking or inability to walk or stand

• Muscle weakness in different parts of the body (mild or severe)

• Numbness, tingling, or loss of sensation.

• Stiff back or neck

• Scoliosis or other spinal deformities; resulting from a large and destructive tumor.

• Paralysis may occur in varying degrees and in different body parts, depending on which nerves the tumor is compressing.

Diagnosis and Detection Tests

Getting an accurate diagnosis of a spinal tumor is crucial for the effective formulation of the treatment plan. This process typically involves:

• Analysis of the patient's history regarding current symptoms, pre-existing conditions, past illnesses, injuries, medications, diet and lifestyle, and genetics.

• Physical examination of the back, neck, and the suspected area for detection of any lesion, bump, instability, or other abnormalities.

• Blood tests may also form part of the diagnostic process to help screen for spinal cancer.

• Further clinical investigations involving medical imaging processes like Computed tomography (CT) scan, Magnetic resonance imaging (MRI) scan, Positron emission tomography (PET) scan, and Bone scan.

• Biopsy for confirmation and comprehensive examination of the tumor.

Management and Treatment

Treatment of spinal tumors is highly individualized and depends on the tumor's location, size, type, and aggressiveness. Certain benign spinal tumors and cysts may not need treatment if they don't cause symptoms. However, regular MRI monitoring is necessary to scrutinize any unfavorable developments. The primary goals of spinal tumor treatment focus on the following:

• Relieving the pain.

• Maintaining or improving the function of the spine and spinal nerves, and

• Improving the quality and length of life.

The treatment options may include a single or combination of therapies like:

• Chemotherapy

• Radiation therapy, including targeted proton therapy

• Stereotactic Radiosurgery

• Full or partial surgical removal of the tumor

• Medications including steroids to combat swelling and back pain

Recent Advancements 

Minimally invasive procedures: Techniques such as endoscopic spine surgery and robotic-assisted surgery enable surgeons to navigate the delicate structures of the spine with unparalleled accuracy, leading to shorter recovery times and improved post-operative outcomes for patients.

Targeted therapies and immunotherapies:  These therapies attack cancer cells directly or harness the body's immune system to recognize and destroy tumor cells. They exhibit greater efficacy and fewer side effects than traditional chemotherapy or radiation.

Advanced radiation therapy: Techniques such as stereotactic radiosurgery and proton therapy deliver high doses of radiation precisely to the tumor site without damaging healthy surrounding tissue. This precision targeting improves treatment outcomes and reduces the risk of radiation-related complications, allowing patients to maintain a higher quality of life during and after treatment.

When to see a doctor

Early diagnosis and treatment are crucial in the case of spinal tumors. Seek immediate medical attention if one experiences:

• Progressive muscle weakness or numbness in legs or arms

• Changes in bowel or bladder function

• have a history of cancer 

• develop new back pain

• Back pain that is:

• persistent and progressive

• not activity related

• gets worse at night

• accompanied by nausea, vomiting, or dizziness